ST. LOUIS — When Cattrina Hopper got sick last year, she tried to tough it out.
Hopper, 18, doesn't have health insurance. "I kind of had to live with it," she said. "Then I had to go to the hospital, so we ended up with a hospital bill."
She still doesn't have insurance, but now she has health care. That's because she attends Roosevelt High School in St. Louis, the site of a new clinic run by Mercy that cares for the school's students and staff members. When an in-school day care center for students' babies and toddlers opens this fall, the clinic will care for them as well. The clinic accepts insurance plans and Medicaid, and anyone without insurance is treated at no cost. When an eligible student is not on Medicaid, the clinic's staffers help the student sign up.
"Mercy is always looking to provide innovation with regards to the delivery of care," said Dr. Bob Bergamini, medical director for Mercy's Center for Innovative Care in St. Louis. "Health care reform aside, American medicine is in need of change, and Mercy is trying out different care models and trying to take care to the patients rather than make the patients travel."
Mercy has hospitals and clinics in Kansas, Oklahoma, Arkansas and Missouri. This is its first in-school clinic.
Bergamini noted that the Sisters of Mercy always have worked with the underserved, stepping in wherever they see a need. "Certainly, the Roosevelt community exemplifies a community that has significant diverse needs," he said. "This fits right into Mercy's mission today and is a good representation of the historical moral drive."
The majority of Roosevelt's students qualify for free or reduced-price lunches, Bergamini said. "We figured most of those (students) would be Medicaid-eligible."
St. Louis Public Schools used $300,000 of a 2010 bond issue to build the clinic in a wing that had held classrooms, said
Patrick Wallace, the district's executive director of communications. Mercy is using half of a $1 million grant from Boeing to staff and equip the clinic, Bergamini said. (The remaining $500,000 is going to Mercy Hospital's JFK Clinic in Creve Coeur, Mo., which also serves uninsured and underinsured patients.)
Melting pot
Family nurse practitioner Kathleen Woods and practice manager Aigner Channel staff the Roosevelt clinic. As a nurse practitioner, Woods can write prescriptions, which are transmitted electronically to the patients' pharmacies. The clinic is part of Mercy's family medicine practice, which has eight physicians, Bergamini said, and Woods can call upon them as needed. When time and money allow, Mercy plans to begin offering dental and mental health care at the clinic.
Roosevelt is located in south St. Louis, where many immigrants have settled. At last count, 124 of the school's 700 students speak English as a second language, Bergamini said.
The most common non-English language at the school is Bosnian, Wallace said. Students also speak Somali, Spanish, Nepali, Grebo (West Africa), Vietnamese, Arabic, Rwandan, Swahili, French, West African Creole, Farsi, Turkish, Uzbek, Lao, Burmese, Albanian, Philippine Native, Tigrinya (Ethiopia and Eritrea), Kunama (Ethiopia and Eritrea) and Creole French.
Mercy has contracted with a staff of interpreters in Washington state who are fluent in 180 languages to translate during clinic visits. The translators of eight commonly used languages work via video, and the remainder work over a voice-only connection.
"The nurse practitioner can punch a button, and within 30 to 45 seconds, you can have an interpreter," Bergamini said. If the patient needs privacy during a video session, Woods turns off the camera, and a curtain is drawn across the video screen.
Motivated students
Woods can care for about 20 patients a day. "I've seen sick kids, allergies, sinusitis, poison ivy. I've seen sprains," she said. "I had one girl come in, she wanted a physical. She was taking responsibility for herself. You have to give her kudos for that."
If a student is under 18, Woods needs a consent form from a parent or guardian. The school mailed out forms and handed them out at registration. Once a form is signed, it's good as long as the student is in school. By mid-September, almost half of the minor students had consent forms on file.
Early in the school year, most of the appointments were for sports physicals. Without an annual physical, students can't play sports or even practice, which historically has kept many Roosevelt players off the court or field for weeks. The in-school clinic has changed that. "The coaches have said it's a big help," Woods said.
Hopper, a senior on the tennis team, visited the clinic for a sports physical, as did Darrius Euell, 15, a sophomore who plays basketball and runs cross-country.
"I think it's cool," Euell said. "When people get sick, they can come here instead of going home."
Taking attendance
And in fact, the clinic should reduce absenteeism among students and staff. Because teachers aren't able to leave school during the day, a doctor's appointment used to mean that they had to miss a day of school and the district had to hire a substitute teacher, Wallace said.
Roosevelt High also has a school nurse. In previous years, the school nurse sent sick and potentially contagious students home until they could visit a doctor, which often took days. Now those students can visit the in-school clinic.
Bergamini mentioned a newly diagnosed asthmatic who was having trouble with her medicines. "The nurse practitioner was able to make some adjustments to the meds," he said. "Now she's missing a period instead of a day or three days." Another student came to school with a rash. Woods ascertained that it wasn't contagious and sent the student back to class.
Multiplier effects
The facility at Roosevelt High is among about 2,100 school-based health clinics across the United States, according to the National Assembly on School-Based Health Care. About a third of those are in high schools, and slightly more than half are in urban areas.
Their numbers are increasing, said Joanna Kuebler, the assembly's communications director. Financing comes from a variety of sources. "It's a carefully crafted quilt of funding: federal grants, state grants, foundations, private money," she said.
School-based clinics will become even more important when the Patient Protection and Affordable Care Act goes fully into effect, she said. "It's a replicable model, it's a cost-effective model, it's something that we hope to see available to every population and community that needs it," she said.
Bergamini already has fielded requests for more in-school clinics. "We want to find out what the needs are at Roosevelt before we jump in and do some more," he said. "I hope we'll be able to find other partners like Boeing who will be willing to step up and help the kids."
Copyright © 2012 by the Catholic Health Association of the United States
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